Subject(s)
Breast Neoplasms , Radiosurgery , Humans , Breast Neoplasms/pathology , Breast Neoplasms/radiotherapy , Female , Radiosurgery/methods , Neoplasm Staging , Probiotics/therapeutic use , Probiotics/administration & dosage , Lymph Nodes/pathology , Axilla , Lymphatic Metastasis/pathology , Ultrasonography/methodsSubject(s)
Endometrial Neoplasms , Esophageal Neoplasms , Neuroma, Acoustic , Uterine Cervical Neoplasms , Humans , Female , Neoadjuvant TherapyABSTRACT
OBJECTIVES: Cancer is an insidious and devastating disease that affects many people. Progress in mortality rate has not been realized universally across the United States, and challenges remain in how to best make up the ground that has been lost in these areas, one of which is Mississippi. Radiation therapy is a significant contributor to cancer control rates and certain challenges exist specifically regarding this treatment modality. METHODS: The challenges of radiation oncology in Mississippi have been reviewed and discussed, with the proposal of a potential collaboration between clinical practitioners and payors to provide optimal and cost-effective radiation therapy to patients in Mississippi. RESULTS: A similar model to that proposed has been reviewed and evaluated. This model is discussed based on its potential validity and usefulness in Mississippi. CONCLUSIONS: Significant barriers exist in the state of Mississippi to patients receiving a consistent standard of care, regardless of their location and socioeconomic status. A collaborative quality initiative has been shown to be a boon to this endeavor elsewhere and stands to have a similar impact in Mississippi.
Subject(s)
Neoplasms , Radiation Oncology , Humans , United States , Mississippi , Neoplasms/radiotherapy , Patient CareSubject(s)
Brachytherapy , Lung Neoplasms , Radiotherapy, Image-Guided , Small Cell Lung Carcinoma , Uterine Cervical Neoplasms , Female , Humans , Brachytherapy/adverse effects , Uterine Cervical Neoplasms/diagnostic imaging , Uterine Cervical Neoplasms/radiotherapy , Uterine Cervical Neoplasms/pathology , Magnetic Resonance Imaging , Lung Neoplasms/radiotherapy , Radiotherapy DosageSubject(s)
Breast Neoplasms , Carcinoma, Intraductal, Noninfiltrating , Carcinoma, Merkel Cell , Lung Neoplasms , Nasopharyngeal Neoplasms , Radiosurgery , Sarcoma , Skin Neoplasms , Soft Tissue Neoplasms , Male , Humans , Breast Neoplasms/pathology , Carcinoma, Merkel Cell/radiotherapy , Prostate/pathology , Nasopharyngeal Carcinoma/radiotherapy , Lung Neoplasms/pathologySubject(s)
Craniospinal Irradiation , Prostatic Neoplasms , Androgen Antagonists/pharmacology , Androgen Antagonists/therapeutic use , Androgens , Humans , Lymph Nodes/pathology , Male , Neoadjuvant Therapy , Neoplasm Recurrence, Local , Prone Position , Prostate/pathology , Prostate-Specific Antigen , Prostatic Neoplasms/drug therapy , Prostatic Neoplasms/radiotherapy , Salvage TherapySubject(s)
Nasopharyngeal Neoplasms , Prostatic Neoplasms , Rectal Neoplasms , Antineoplastic Combined Chemotherapy Protocols , Chemoradiotherapy/methods , Cisplatin/therapeutic use , Early Detection of Cancer , Humans , Magnetic Resonance Imaging , Male , Nasopharyngeal Carcinoma/therapy , Nasopharyngeal Neoplasms/diagnostic imaging , Nasopharyngeal Neoplasms/therapy , Neoadjuvant Therapy , Neoplasm Staging , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/drug therapy , Rectal Neoplasms/pathologySubject(s)
Breast Neoplasms , Lung Neoplasms , Pancreatic Neoplasms , Prostatic Neoplasms , Androstenes , ErbB Receptors/genetics , Humans , Lung Neoplasms/genetics , Lung Neoplasms/pathology , Lung Neoplasms/therapy , Male , Neoadjuvant Therapy , Pancreatic Neoplasms/therapy , Prostatic Neoplasms/genetics , Prostatic Neoplasms/therapy , Pancreatic NeoplasmsABSTRACT
Classically, prostate cancer has been diagnosed via systematic, transrectal ultrasound-guided biopsy prompted by an abnormal digital rectal exam or elevated serum prostate-specific antigen (PSA) level. The development of multi-parametric magnetic resonance imaging (MRI) has led to improved detection of prostate cancer foci. For patients with clinically localized prostate cancer seeking definitive therapy through radiation therapy, external beam radiation has been a mainstay with a movement toward hypofractionation, notably prostate stereotactic body radiotherapy (SBRT). We aim to describe the practical aspects of establishing a multidisciplinary, MRI-based prostate SBRT program by means of case examples. The prostate SBRT team at the University of Alabama at Birmingham has been performing prostate SBRT for over four years using a multidisciplinary workflow. We have additionally completed a phase II trial of prostate SBRT with additional targeting of intraprostatic lesions with higher doses of radiation using a simultaneous integrated boost technique. While there have been no reported randomized trials of prostate SBRT, this treatment has been proven safe and effective for properly selected patients with low and intermediate-risk prostate cancer. We present our multidisciplinary approach to prostate SBRT with two clinical cases targeting high-risk [MAM1] lesions in different anatomic zones of the prostate highlighting pertinent clinical challenges in successfully delivering prostate SBRT and managing potential side effects. In conclusion, we report a multidisciplinary, MRI-based approach to treating patients with ultra hyperfractionated stereotactic radiosurgery as primary definitive treatment for prostate cancer.
